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Uterine Inversion

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101. Management of Neonates Born at ?34 6/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis

the definition is used to specify a series of time-sensitive interventions. The current overall incidence of EOS in the United States is approximately 0.8 cases per 1000 live births. A disproportionate number of cases occur among infants born preterm in a manner that is inversely proportional to gestational age at birth. The incidence of EOS is approximately 0.5 cases per 1000 infants born at ≥37 weeks’ gestation, compared with approximately 1 case per 1000 infants born at 34 to 36 weeks’ gestation, 6 cases (...) is complex. EOS primarily begins in utero and was originally described as the “amniotic infection syndrome.” , Among term infants, EOS pathogenesis most commonly develops during labor and involves ascending colonization and infection of the uterine compartment with maternal gastrointestinal and genitourinary flora, with subsequent colonization and invasive infection of the fetus and/or fetal aspiration of infected amniotic fluid. This intrapartum sequence may be responsible for EOS that develops after

2018 American Academy of Pediatrics

103. Muscle-invasive and Metastatic Bladder Cancer

, and late gadolinium-enhanced imaging. Radiology, 1994. 193: 239. 103. Kim, J.K., et al. Bladder cancer: analysis of multi-detector row helical CT enhancement pattern and accuracy in tumor detection and perivesical staging. Radiology, 2004. 231: 725. 104. Yang, W.T., et al. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol, 2000. 175: 759. 105. Kim, S.H., et al. Uterine cervical carcinoma: evaluation of pelvic lymph (...) node metastasis with MR imaging. Radiology, 1994. 190: 807. 106. Kim, S.H., et al. Uterine cervical carcinoma: comparison of CT and MR findings. Radiology, 1990. 175: 45. 107. Oyen, R.H., et al. Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients. Radiology, 1994. 190: 315. 108. Barentsz, J.O., et al. MR imaging of the male pelvis. Eur Radiol, 1999. 9: 1722. 109. Dorfman, R.E., et al. Upper abdominal lymph nodes

2018 European Association of Urology

106. Obtaining Valid Consent to Participate in Perinatal Research Where Consent is Time Critical

that may not apply to them. • For conditions with a suspected risk of occurrence of less than 1/100 (for example, shoulder dystocia, unexplained preterm labour or uterine inversion), careful consideration should be given to avoiding unnecessary physical and psychological stress by providing detailed information about scenarios and situations that are rare. Therefore, it is appropriate for summary information to be available antenatally and the full study information to be given if the event happens

2016 Royal College of Obstetricians and Gynaecologists

107. Lymphangioleiomyomatosis Diagnosis and Management Part II: An Official ATS/JRS Clinical Practice Guideline

and diagnostic yield of these methodologies, however, is not well established and needs to be studied. Consultation with expert LAM centers is advised to individualize the approach to diagnosis in complex patients. On occasion, re-review of archival tissues from prior procedures by expert pathologists can revealthediagnosisofLAMandobviatethe need for biopsy. Examples include lung tissue obtained from prior bleb resections for pneumothorax or uterine and adnexal tissues from prior hysterectomies. Every (...) is required to optimize the safety and ef?cacy of this diagnostic approach. A recent study evaluating the role of transbronchial lung biopsy in 24 consecutive patients presenting toa LAMClinicrevealedadiagnosticyieldof 71%, which was inversely correlated with DL CO (43). Consultation with an expert centerbeforeundertakingtransbronchiallung biopsy, combined with a critical review of the tissue specimens by a pathologist with expertise in LAM, can help avoid false- negative test results and the need

2017 American Thoracic Society

108. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

predictive indicator appears to be of most value. In 1 series, the negative predictive value of NT-pro-BNP <128 pg/mL at 20 weeks’ gestation exceeded 95%. Colloid Oncotic Pressure Circulating albumin concentrations fall 12% to 18% in pregnancy, with the lowest levels at ≈24 weeks’ gestation. The decline in colloid oncotic pressure, along with increased femoral venous pressure caused by uterine compression of the inferior vena cava, elicits the edema of pregnancy. , The fall in oncotic pressure can (...) of the first stage of labor, with further increases during uterine contractions. , , Uterine contractions augment maternal cardiac output as a result of enhanced sympathetic activity (via anxiety, pain) and expulsion of uterine blood into the central venous circulation. During a contraction, the uterus expels up to 400 mL blood into the central venous circulation, leading to a rise in central venous pressure, right atrial pressure, cardiac output, and arterial pressure. The labor-induced augmentation

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2017 American Heart Association

109. Normal birth

IM after birth of baby o Wait at least 1–3 minutes after birth or for cord pulsation to cease and then clamp and cut cord o Controlled cord traction and uterine guarding after signs of separation o Prolonged after 30 minutes · Physiological o Suitable for well women without risk factors o Placenta birthed by maternal effort/gravity o Oxytocin not administered o Clamp cord after pulsation ceased o No controlled cord traction o Prolonged after 60 minutes · If concern with cord integrity or FHR: o (...) · Provides mild analgesia and sedation 112 · Minimal toxicity · Fast acting with rapid elimination 112,114 · No effect on uterine contractility · No known fetal or neonatal effects 114,115 · Effective for labour pain 73,116 · Can assist relaxation (breathing techniques) Risk · Overdose causes respiratory depression o Risk increased when used with opioid · Associated with: o Vomiting, nausea, headache and dizziness 73,110,114,116 o Disorientation and claustrophobia 73 · Can be minimised by careful

2017 Queensland Health

113. Quality measures in high-risk pregnancies: Executive summary of a cooperative workshop of SMFM, NICHD, and ACOG

VBAC rates inversely are correlated with total cesarean rates; repeat cesarean deliveries are associated with increased morbidity over time; VBAC counseling in?uences uptake of attempted trial of labor. Unclear VBACratedependsonaccess; many hospitals do not meet standards or have chosen not to offer VBAC for risk management reasons; potential for downstream complications if incentivized for VBAC success. Yes Can use administrative data for VBAC rate and VBAC success rate. No TOLAC counseling Yes (...) . Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantialnumberofwomenwithashortcervix.JMaternFetalNeonatal Med 2012;25:1682-9. 23.Friedman A, Srinivas S, Elovitz M, Wang E, Schwartz N. Can trans- abdominalultrasoundbeusedasascreeningtestforshortcervicallength? Am J Obstet Gynecol 2013;208:190-7. 24.Meis PJ, Klebanoff M, Thom E, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003;348:2379-85. 25.Orsulak MK

2017 Society for Maternal-Fetal Medicine

114. Postpartum Hemorrhage

% of cases of PPH Retained placental tissue or clots prevent occlusion of uterine blood vessels • Retained placenta, placental fragments, clots, lobe or membranes • Abnormal placentation - placenta accreta/increta/percreta TRAUMA Accounts for an estimated 20% of cases of PPH Blood loss due to genital tract trauma • Lacerations and hematomas of vagina, perineum or cervix • Laceration at CS, extension of incision • Uterine rupture • Uterine inversion THROMBIN Accounts for an estimated 1% of cases of PPH (...) ? 20 Components of the active management package 21 What is the best time to administer a prophylactic uterotonic? 21 What route is most effective for administration of prophylactic oxytocin? 21 How does timing of cord clamping affect PPH and neonatal outcomes? 21 What is the effect of umbilical cord drainage? 21 What are the effects of uterine massage? 21 What are the effects of controlled cord traction? 22 Active management and controlled cord traction 22 Expectant management and controlled cord

2016 Ontario Midwives

115. Fertility drugs and cancer: a guideline

, ovula- tion induction, ovulation induction/ adverse effects[MeSH], thyroid neo- plasms/chemically induced[MeSH], thy- roid neoplasms/epidemiology[MeSH], thyroid neoplasms/etiology[MeSH], thy- roid, treatment, treatments, uter*, uter- ine cervical neoplasms/chemically induced[MeSH], uterine cervical neo- plasms/epidemiology[MeSH], uterine cervical neoplasms/etiology[MeSH], uterine, uterus. Studieswereeligibleiftheymetone of the following criteria: primary evi- dence (clinical trials) that assessed (...) . In addition, sal- pingectomy prior to IVF is now an accepted treatment for those with severe tubal disease, and this may have implica- tions for the incidence of ‘‘ovarian’’ cancers, given the newer theoriesthatsomeovariancancersmayoriginateinthefallo- pian tube (7). OvarianCancer Ovarian cancer is rare and accounts for about 3% of all can- cers in women, with approximately 20,000 cases diagnosed annually in the United States (8). Parity is inversely related to the risk of ovarian cancer (odds ratio

2016 Society for Assisted Reproductive Technology

116. Establishing breastfeeding

, Aboriginal and Torres Strait Islander women 2 , adolescent/young women 2 , history of abuse or substance use 45,46 ) o Breast and nipple variations, surgery or injury (e.g. breast hypoplasia, biopsy, augmentation, reduction, nipple inversion, nipple piercing) 39 as disclosed by the woman in response to prompts o Current medications o Use of tobacco, alcohol or illicit drugs • If history identifies risk factors, consider breast examination (not routinely recommended 47 ) as it provides an opportunity (...) reflex (MER) influences amount of milk baby consumes regardless of the length of the breastfeed 70 o MER may take two to three minutes to occur in the first few days after birth 39 • Multiple milk ejections are common during a breastfeed however the mother may not sense it or may only sense the initial MER • Woman may sense or notice MER by 70 : o Becoming thirsty o Breast sensations (e.g. pins and needles, pressure, milk leakage) o Uterine contractions ‘afterbirth pains’ in the immediate postpartum

2016 Queensland Health

117. Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae

, and computed tomography (CT). Fluid-sensitive sequences are the favored initial sequence for MRI screening [29]. With a small field of view, short tau inversion recovery and/or T1-weighted imaging will usually demonstrate a fracture line surrounded by edema. In the absence of an actual stress fracture, stress reaction or muscle/tendon injuries can be identified using fluid-sensitive sequences. Thus, MRI may be as sensitive as bone scintigraphy but also considerably more specific [19,23]. Intravenous (...) stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings. Skeletal Radiol. 2002;31(5):277-281. 6. Bernhard A, Milovanovic P, Zimmermann EA, et al. Micro-morphological properties of osteons reveal changes in cortical bone stability during aging, osteoporosis, and bisphosphonate treatment in women. Osteoporos Int. 2013;24(10):2671-2680. 7. Tokumaru S, Toita T, Oguchi M, et al. Insufficiency fractures after pelvic radiation therapy for uterine cervical

2016 American College of Radiology

118. Establishing breastfeeding

, Aboriginal and Torres Strait Islander women 2 , adolescent/young women 2 , history of abuse or substance use 45,46 ) o Breast and nipple variations, surgery or injury (e.g. breast hypoplasia, biopsy, augmentation, reduction, nipple inversion, nipple piercing) 39 as disclosed by the woman in response to prompts o Current medications o Use of tobacco, alcohol or illicit drugs • If history identifies risk factors, consider breast examination (not routinely recommended 47 ) as it provides an opportunity (...) reflex (MER) influences amount of milk baby consumes regardless of the length of the breastfeed 70 o MER may take two to three minutes to occur in the first few days after birth 39 • Multiple milk ejections are common during a breastfeed however the mother may not sense it or may only sense the initial MER • Woman may sense or notice MER by 70 : o Becoming thirsty o Breast sensations (e.g. pins and needles, pressure, milk leakage) o Uterine contractions ‘afterbirth pains’ in the immediate postpartum

2016 Clinical Practice Guidelines Portal

120. Developmental rheumatology in children. Scenario: Out-toeing

pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying foot (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

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